Physician does a new patient visit and he calls for a stat CT and patient comes back again in the afternoon after the CT scan and he does another and established office visit. What is the critieria can he bill for two office visits on the same day and we have documentation that he has performed each one of them.
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2 office visits on same day
- Thread starter cbowman1
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mcintireh
Guest
I am assuming that this was for the same problem and therefore same diagnosis. In this case, I don't think you should bill for two visits. You should bill one E/M code based on the "bullets" that were documented in both visits. You may want to consider the "prolonged care" code if the additional services provided qualify.
Holly M.
Holly M.
Kelly Taylor
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The general rule of thumb is that there can only be one E/M code per day. Per the CPT manual, "The most common practice is to report a single visit code per day, evaluating all services provided during that day to arrive at the correct level of service. Prolonged service codes may be used to report services beyond the usual."
So, combine the two services together, which may result in a higher level new pt visit or if the two services together were extensive, you may be able to use the prolonged service code(s). Hopes this helps.
So, combine the two services together, which may result in a higher level new pt visit or if the two services together were extensive, you may be able to use the prolonged service code(s). Hopes this helps.
mmelcam
Expert
You can only code one e&m per day. Just use documentation for both of the visits to come up with the e&m level.
Belinda Frisch
Guru
Documentation is key
If you have separate documentation for both visits, I'd bill both and append modifier 25 to the second.
That being said, I assume you will have separate diagnoses. The first should be for the symptoms prompting the CT, the second should be the definitive diagnosis as a result of the CT.
You should bill these claims together, on a paper claim form, with a brief explanation of the separateness and documentation of both encounters attached. You may have to appeal a decision to rebundle the claims, but you should win if you try. You may want to direct the claims to your provider representative right off the bat if they are willling to accept it; they can be very helpful in these rare, sticky situations.
If you have separate documentation for both visits, I'd bill both and append modifier 25 to the second.
That being said, I assume you will have separate diagnoses. The first should be for the symptoms prompting the CT, the second should be the definitive diagnosis as a result of the CT.
You should bill these claims together, on a paper claim form, with a brief explanation of the separateness and documentation of both encounters attached. You may have to appeal a decision to rebundle the claims, but you should win if you try. You may want to direct the claims to your provider representative right off the bat if they are willling to accept it; they can be very helpful in these rare, sticky situations.
jamcculley
Contributor
I do not agree with the 25 modifier solution. You should combine the documentation and see what new patient office visit level of service the documentation supports.
okiesawyers
Expert
Lisa Bledsoe
True Blue
I believe that the only way a modifier -25 could be reported is if the problem for the second visit was COMPLETELY different from the first. In the case here, it is the same problem and should only be coded as one visit - the higher of the two documented visits.
Lisa
Lisa
Networker3412
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What about when a physician sees a patient and bills an E&M code and an occupational therapist also bills out an E&M code? Does anyone know how to code for that? 99211 and 99212 can also be used for clinic assessments for rehab services. My situation is that we have a physician that sees the patient and refers the patient to the OT on the same day in the physician;s clinic. The OT is not employed by the physician but employed by the hospital so that hospital would bill out the OT charges. The physician bills out their E&M code and then we bill out ours. Does anyone know how to code for that?
codegirl0422
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I agree to combine the visits. You may want to check with the insurance carrier. I know our BCBS does not recongize modifier 25 in any case. Our Medicare will only pay one E/M visit per day, same for Aetna and UHC.
Same day Visit 2 different specialities same tax id #
Established pt came into clinic for PHE . Pt also scheduled to see Pod. for her ingrown nails. How would i bill and would i get paid since both Doc's are in the same practice using the same tax id #?
Established pt came into clinic for PHE . Pt also scheduled to see Pod. for her ingrown nails. How would i bill and would i get paid since both Doc's are in the same practice using the same tax id #?
Guideline is: 2 visits ....different specialties = 2 E&M codes
First you have to determine if the patient is NEW or EST with each specialty
A new patient (99201-99205) is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”
You didnt say what specialty was doing the preventive visit. But lets say it is a FP physician and the patient is an established patient to FP. So he gets an Est patient preventive E&M code (99391-99394 etc) with the appropriate V code DX.
The podiatrist, same group but different speciality. Let's say the Pt is a New patient to podiatry. He codes the appropriate 99201-99205 for the eval of the toenails. If he does any procedures then you will have to see if the documentation supports a separate E&M (mod -25) or his eval becomes inclusive to the procedure as "pre-procedure work".
First you have to determine if the patient is NEW or EST with each specialty
A new patient (99201-99205) is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”
You didnt say what specialty was doing the preventive visit. But lets say it is a FP physician and the patient is an established patient to FP. So he gets an Est patient preventive E&M code (99391-99394 etc) with the appropriate V code DX.
The podiatrist, same group but different speciality. Let's say the Pt is a New patient to podiatry. He codes the appropriate 99201-99205 for the eval of the toenails. If he does any procedures then you will have to see if the documentation supports a separate E&M (mod -25) or his eval becomes inclusive to the procedure as "pre-procedure work".
jkh429
Networker
Ok, so I kind of have the same issue. Patient came in for a sports physical. The patient then came back later in same day for an inhaler refill. We billed two seperate visits with 2 different diagnosis codes. The insurance is denying as 2 e/m codes in same day. What would we do to get paid on this? Same tax id and specialty, but 2 different providers. Please help! Thanks
2 physicians -- same group---same specialty---2 different DX ---should mean 2 E&M codes. But the paste below is CMS guidelines. Non-Medicare payers can make their own payment guidelines.
You didn't say so I am assuming your sports physical met the guidelines for preventive and was coded as preventive while the med refill was coded 99212-99215
I can see that the payer would question a 2nd visit for a med refill when that is a such a basic component of a preventive care visit. I could see the payer asking why the med refill was not done during the preventive encounter, expecially since both physicians are the same specialty. Payer could also question why the routine med refill was not done as a f/up phone call or nurse visit (extension of physician's visit). Did the patient just forget to ask for this inhaler refill when he was seeing the physician?
Physicians in Group Practice
Physicians of the same specialty in the same group practice must bill and be paid as a single physician.
If more than one E/M (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E/M service may be reported unless the E/M services are for unrelated problems.
Physicians in different specialties in the same group practice may bill and be paid without regard to their membership in the same group.
You didn't say so I am assuming your sports physical met the guidelines for preventive and was coded as preventive while the med refill was coded 99212-99215
I can see that the payer would question a 2nd visit for a med refill when that is a such a basic component of a preventive care visit. I could see the payer asking why the med refill was not done during the preventive encounter, expecially since both physicians are the same specialty. Payer could also question why the routine med refill was not done as a f/up phone call or nurse visit (extension of physician's visit). Did the patient just forget to ask for this inhaler refill when he was seeing the physician?
Physicians in Group Practice
Physicians of the same specialty in the same group practice must bill and be paid as a single physician.
If more than one E/M (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E/M service may be reported unless the E/M services are for unrelated problems.
Physicians in different specialties in the same group practice may bill and be paid without regard to their membership in the same group.
AlwaysLearningCoder
Contributor
I have a question.. If we have an Orthopedic Hand Surgeon and a PA evaluate a New patient on the same day for different issues/diagnosis.. are we then able to bill 2 NP evals under 2 different providers within 1 group.. This patient has HN - please reply asap.. pending denied claim and coding conflict.
thank you
-D
thank you
-D
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The most common practice is to report a single visit code per day, evaluating all services provided during that day to arrive at the correct level of service. Prolonged service codes may be used to report services beyond the usual."
where is the CPT can I find the quote above???
where is the CPT can I find the quote above???
kinda same issue
I had a physician seeing a patient yesterday for edema and during the exam he sees that she now has a new onset of DM, he bills for his visit and then our PA saw the patient to do the DM teaching (upon patient request that she lives to far away to make a special trip in just for the teaching) which we are able to bill under the PA and just get reduced reimbursement. I am not sure if I bill both e/m codes or what is the correct procedure for this situation. Any advise would be greatly appreciated.
I had a physician seeing a patient yesterday for edema and during the exam he sees that she now has a new onset of DM, he bills for his visit and then our PA saw the patient to do the DM teaching (upon patient request that she lives to far away to make a special trip in just for the teaching) which we are able to bill under the PA and just get reduced reimbursement. I am not sure if I bill both e/m codes or what is the correct procedure for this situation. Any advise would be greatly appreciated.
mitchellde
True Blue
you cannot bill two visits either you must combine both and bill it as a shared encounter. Per CR 1776.
who to bill under
Hello, I understand the process of combining documentation from same specialty E/M visits on the same day to make one E/M visit. Does anyone know if there is documentation out there that states which MD/PA etc. to bill under or is that decided internally?
Hello, I understand the process of combining documentation from same specialty E/M visits on the same day to make one E/M visit. Does anyone know if there is documentation out there that states which MD/PA etc. to bill under or is that decided internally?
who to bill under
I understand the process of combining documentation from same specialty E/M visits on the same day to make one E/M visit. Does anyone know if there is documentation out there that states which MD/PA etc. to bill under or is that decided internally?
I understand the process of combining documentation from same specialty E/M visits on the same day to make one E/M visit. Does anyone know if there is documentation out there that states which MD/PA etc. to bill under or is that decided internally?
adascoli87
Guest
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But it is an issue..
I also work for 3 orthopaedic surgeons and we have a therapy department in the practice also, is there not a modifier we can use to seperate them?
I also work for 3 orthopaedic surgeons and we have a therapy department in the practice also, is there not a modifier we can use to seperate them?